Comparison of effectiveness of cortical bone trajectory screw fixation and pedicle screw fixation in posterior lumbar interbody fusion_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 PENG Jun , ZHAN Yulin , LIU Yingjie , ZONG Yang , Mao Yanjie

Departmentof Orthopaedics, East Hospital of Shanghai Sixth People’s Hospital, Shanghai, 201306, P.R.China;

Corresponding?author：

PENG Jun, Email: fengfooo@163.com

Keywords：

Degenerative lumbar disease; cortical bone trajectory screw; pedicle screw; posterior lumbar interbody fusion

DOI：

10.7507/1002-1892.201706075

Video：

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Objective To compare the effectiveness of cortical bone trajectory screw (CBTS) and conventional pedicle screw for posterior lumbar interbody fusion (PLIF) in the treatment of single segment lumbar degenerative disease. Methods Between May 2013 and May 2016, a total of 97 patients with single segment lumbar degenerative disease were treated with PLIF. Fifty-one patients were fixed with CBTS in PLIF (trajectory screw group) and 46 with pedicle screw (pedicle screw group). There was no significant difference in age, gender, body mass index, preoperative diagnosis, lesion segment, and preoperative visual analogue scale (VAS) score, Oswestry dysfunction index (ODI) between 2 groups (P>0.05). The operation time, intraoperative blood loss, postoperative drainage, bed rest time, length of hospital stay, serum creatine kinase (CK) concentration, total amount of diclofenac sodium, perioperative complications, ODI, VAS score, and interbody fusion rate were recorded and compared between 2 groups. Results All patients were followed up 12 months. The patients in trajectory screw group had a significantly less operation time, intraoperative blood loss, postoperative drainage, and serum CK concentration when compared with the patients in pedicle screw group (P<0.05). Thirty-five patients (68.6%) in trajectory screw group and 46 patients (100%) in pedicle screw group were given diclofenac sodium within 48 hours after operation, showing significant difference between 2 groups (χ²=89.334, P=0.000). There was no significant difference in the incidence of perioperative complications between trajectory screw group and pedicle screw group (3.9% vs. 8.7%, P=0.418). There was no significant difference in the VAS score, ODI, and interbody fusion rate at 12 months after operation between 2 groups (P>0.05). Conclusion For the single segment degenerative lumbar disease, the use of CBTS or conventional pedicle screw for PLIF can obtain satisfactory clinical function and interbody fusion rate. But the former has the advantages of less blood loss, less intraoperative muscle damage, less perioperative pain, shorter length of hospital stay and bed rest time.

Citation： PENG Jun, ZHAN Yulin, LIU Yingjie, ZONG Yang, Mao Yanjie. Comparison of effectiveness of cortical bone trajectory screw fixation and pedicle screw fixation in posterior lumbar interbody fusion. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(11): 1341-1345. doi: 10.7507/1002-1892.201706075 Copy

1.	李傳玲, 趙楓, 呂輝照, 等. 腰椎融合術后椎體硬化和骨贅的變化. 實用骨科雜志, 2016, 22(12): 1087-1090.
2.	Lechner R, Putzer D, Liebensteiner M, et al. Fusion rate and clinical outcome in anterior lumbar interbody fusion with beta-tricalcium phosphate and bone marrow aspirate as a bone graft substitute. A prospective clinical study in fifty patients. Int Orthop, 2017, 41(2): 333-339.
3.	楊勇, 王清, 徐雙, 等.單側椎板間擴大開窗所獲自體骨行腰椎椎間融合的可行性. 中國脊柱脊髓雜志, 2017, 27(2): 142-148.
4.	Bresnahan LE, Smith JS, Ogden AT, et al. Assessment of paraspinalmuscle cross-sectional area after lumbar decompression: minimally invasive versus open approaches.Clin Spine Surg, 2017, 30(3): E162-E168.
5.	Keorochana G, Pairuchvej S, Trathitephun W, et al. Comparative outcomes of cortical screw trajectory fixation and pedicle screw fixation in lumbar spinal fusion: systematic review and meta-analysis. World Neurosurgery, 2017, 102: 340-349.
6.	Santoni BG, Hynes RA, McGilvray KC, et al. Cortical bone trajectory for lumbar pedicle screws. Spine J, 2009, 9(5): 366-373.
7.	宣俊, 徐道亮, 王向陽, 等.皮質骨通道置椎弓根螺釘技術的研究進展. 中華骨科雜志, 2016, 36(1): 51-57.
8.	Lee GW, Son JH, Ahn MW, et al. The comparison of pedicle screw and cortical screw in posterior lumbar interbody fusion: a prospective randomized noninferiority trial.Spine J, 2015, 15(7): 1519-1526.
9.	Kim KT, Lee SH, Suk KS, et al. The quantitative analysis of tissue injury markers after mini-open lumbar fusion. Spine (Phila Pa 1976), 2006, 31(6): 712-716.
10.	Hung CW, Wu MF, Hong RT, et al. Comparison of multifidus muscle atrophy after posterior lumbar interbody fusion with conventional and cortical bone trajectory.Clin Neurol Neurosurg, 2016, 145: 41-45.
11.	Sakaura H, Miwa T, Yamashita T, et al. Posterior lumbar interbody fusion with cortical bone trajectory screw fixation versus posterior lumbar interbody fusion using traditional pedicle screw fixation for degenerative lumbar spondylolisthesis: a comparative study. J Neurosurg Spine, 2016, 25(5): 591-595.
12.	Snyder LA, Martinez-Del-Campo E, Neal MT, et al. Lumbar spinal fixation with cortical bone trajectory pedicle screws in 79 patients with degenerative disease: perioperative outcomes and complications. World Neurosurg, 2016, 88: 205-213.
13.	姚羽, 薛華偉, 趙劍, 等.腰椎皮質骨通道螺釘固定系統的生物力學實驗. 中國組織工程研究, 2017, 21(3): 362-366.
14.	Sansur CA, Caffes NM, Ibrahimi DM, et al. Biomechanical fixation properties of cortical versus transpedicular screws in the osteoporotic lumbar spine: an in vitro human cadaveric model. J Neurosurg Spine, 2016, 25(4): 467-476.
15.	Sakaura H, Miwa T, Yamashita T, et al. Fixation strength of caudal pedicle screws after posterior lumbar interbody fusion with the modified cortical bone trajectory screw method. Asian Spine J, 2016, 10(4): 639-645.
16.	Perez-Orribo L, Kalb S, Reyes PM, et al. Biomechanics of lumbar cortical screw-rod fixation versus pedicle screw-rod fixation with and without interbody support. Spine (Phila Pa 1976), 2013, 38(8): 635-641.
17.	Mitchell SM, Wellington HK. Lumbar pedicle cortical bone trajectory screw: indications and surgical technique. Contemporary Spine Surgery, 2016, 17(1): 6.
18.	Kaye ID, Prasad SK, Vaccaro AR, et al. The cortical bone trajectory for pedicle screw insertion. JBJS Rev, 2017, 5(8): e13.

1. 李傳玲, 趙楓, 呂輝照, 等. 腰椎融合術后椎體硬化和骨贅的變化. 實用骨科雜志, 2016, 22(12): 1087-1090.
2. Lechner R, Putzer D, Liebensteiner M, et al. Fusion rate and clinical outcome in anterior lumbar interbody fusion with beta-tricalcium phosphate and bone marrow aspirate as a bone graft substitute. A prospective clinical study in fifty patients. Int Orthop, 2017, 41(2): 333-339.
3. 楊勇, 王清, 徐雙, 等.單側椎板間擴大開窗所獲自體骨行腰椎椎間融合的可行性. 中國脊柱脊髓雜志, 2017, 27(2): 142-148.
4. Bresnahan LE, Smith JS, Ogden AT, et al. Assessment of paraspinalmuscle cross-sectional area after lumbar decompression: minimally invasive versus open approaches.Clin Spine Surg, 2017, 30(3): E162-E168.
5. Keorochana G, Pairuchvej S, Trathitephun W, et al. Comparative outcomes of cortical screw trajectory fixation and pedicle screw fixation in lumbar spinal fusion: systematic review and meta-analysis. World Neurosurgery, 2017, 102: 340-349.
6. Santoni BG, Hynes RA, McGilvray KC, et al. Cortical bone trajectory for lumbar pedicle screws. Spine J, 2009, 9(5): 366-373.
7. 宣俊, 徐道亮, 王向陽, 等.皮質骨通道置椎弓根螺釘技術的研究進展. 中華骨科雜志, 2016, 36(1): 51-57.
8. Lee GW, Son JH, Ahn MW, et al. The comparison of pedicle screw and cortical screw in posterior lumbar interbody fusion: a prospective randomized noninferiority trial.Spine J, 2015, 15(7): 1519-1526.
9. Kim KT, Lee SH, Suk KS, et al. The quantitative analysis of tissue injury markers after mini-open lumbar fusion. Spine (Phila Pa 1976), 2006, 31(6): 712-716.
10. Hung CW, Wu MF, Hong RT, et al. Comparison of multifidus muscle atrophy after posterior lumbar interbody fusion with conventional and cortical bone trajectory.Clin Neurol Neurosurg, 2016, 145: 41-45.
11. Sakaura H, Miwa T, Yamashita T, et al. Posterior lumbar interbody fusion with cortical bone trajectory screw fixation versus posterior lumbar interbody fusion using traditional pedicle screw fixation for degenerative lumbar spondylolisthesis: a comparative study. J Neurosurg Spine, 2016, 25(5): 591-595.
12. Snyder LA, Martinez-Del-Campo E, Neal MT, et al. Lumbar spinal fixation with cortical bone trajectory pedicle screws in 79 patients with degenerative disease: perioperative outcomes and complications. World Neurosurg, 2016, 88: 205-213.
13. 姚羽, 薛華偉, 趙劍, 等.腰椎皮質骨通道螺釘固定系統的生物力學實驗. 中國組織工程研究, 2017, 21(3): 362-366.
14. Sansur CA, Caffes NM, Ibrahimi DM, et al. Biomechanical fixation properties of cortical versus transpedicular screws in the osteoporotic lumbar spine: an in vitro human cadaveric model. J Neurosurg Spine, 2016, 25(4): 467-476.
15. Sakaura H, Miwa T, Yamashita T, et al. Fixation strength of caudal pedicle screws after posterior lumbar interbody fusion with the modified cortical bone trajectory screw method. Asian Spine J, 2016, 10(4): 639-645.
16. Perez-Orribo L, Kalb S, Reyes PM, et al. Biomechanics of lumbar cortical screw-rod fixation versus pedicle screw-rod fixation with and without interbody support. Spine (Phila Pa 1976), 2013, 38(8): 635-641.
17. Mitchell SM, Wellington HK. Lumbar pedicle cortical bone trajectory screw: indications and surgical technique. Contemporary Spine Surgery, 2016, 17(1): 6.
18. Kaye ID, Prasad SK, Vaccaro AR, et al. The cortical bone trajectory for pedicle screw insertion. JBJS Rev, 2017, 5(8): e13.

Chinese Journal of Reparative and Reconstructive Surgery

Comparison of effectiveness of cortical bone trajectory screw fixation and pedicle screw fixation in posterior lumbar interbody fusion

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